气管插管术

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气管插管术气管插管术

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Contents

定义及概述1

适应症及禁忌症2

操作3

并发症4


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定义Definition

气管插管术是一种将一特制的气管内导管经声门置入气管的技术，这一技术能为气道通畅、通气供氧、呼吸道吸引和防止误吸提供

最佳条件。 The insertion of a tube

into the trachea to allow

air to enter the lungs.


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呼吸道解剖 Anatomy

气管插管的途径是通过鼻腔或口腔，经过咽喉、声门、把插管插到气管或总支气管内。


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ANATOMY OF AIRWAYANATOMY OF AIRWAY


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适应症 Indications

心跳、呼吸骤停。 Cardiac or respiratory arrest

丧失气道保护功能者。 Failure to protect the airway

严重呼吸衰竭不能满足机体通气和氧供需要需机械通气者。

Inadequate oxygenation or ventilation


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适应症 Indications

即将发生或已发生的气道阻塞 Impending or existing airway obstruction

多系统疾病或损伤的护理需要。 Care of critically ill patients with multi-system

disease or injuries.

外科手术麻醉需要。 Control of the airway in surgical procedures

requiring general anesthesia.


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禁忌症 Contraindications

无绝对禁忌症，以下所列为相对禁忌症。由于外部原因所致上气道梗阻 Obstruction of the

upper airway due to foreign objects 颈椎骨折 Cervical fractures 食道疾病 Esophageal disease 进食腐蚀性物质 Ingestion of caustic

substances 下颚骨折Mandibular fractures 喉头水肿 Laryngeal edema 烫伤或化学药剂灼伤 Thermal or chemical burns


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插管前准备 Equipment preparation

1.气管导管导管的选择 Size of endotracheal tube

按导管的内径计算internal diameter (ID)

男性Male: ID 8.0 mms

女性 Female : ID 7.5 mms


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儿童的导管选择 Size of endotracheal tube

0-3月（ New born - 3 months ） : ID 3.0 mm

3-9 月（ 3-9months ） : ID 3.5 mm

9-18 月（ 9-18 months ） : ID 4.0 mms

2- 6岁（ 2-6years） : ID= (Age/3) + 3.5

> 6 岁（ > 6 years） : ID = (Age/4) + 4.5


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插管深度 Depth of endotracheal tube

成人 Adult

男性Male = 23 cms

女性 Female = 21 cms儿童 Children

经口气管插管 = (Age/2) + 12 (cm)

经鼻气管插管 = (Age/2) + 15 (cm)


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2. 喉镜 Laryngoscope 气管插管使用的为直接喉镜。直接喉镜分直镜（miller）和弯镜（ macintosh）两种。


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操作前务必检查喉镜是否明亮


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其他 Other equipments导丝 Stylet

手套 Gloves

吸痰器 Suction Device

5ML 注射器 syringe

固定器 Endotracheal tube holder


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操作步骤 PROCEDURAL STEPS

1．仰卧，头垫高 10cm，置入导管芯 ,将病人头部尽量向后伸仰，使三轴线完全重叠，让插管径路接近为一直线。

Position bed height to bring the patient's head to a mid-abdominal height.Flex the cervical spine and extend the head at the atlanto-occipital joint.Long axis of the oral cavity, pharynx, and trachea lie almost in a straight line.


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2.左手持喉镜沿右口角置入口腔，左推舌体，使喉镜移至正中位。 Introduce the blade into the right side of the patient's mouth, move the blade posteriorly and toward the midline, sweeping the tongue to the left and keeping it away from the visual path with the flange of the blade

3．喉镜片抵达舌根与会厌交界处，上提喉镜，撬起会厌 ,显露声门。 advance the laryngoscope until the epiglottis is in view.


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4.右手以握笔式手势持气管导管，插过声门 , 进入气管。 lift the laryngoscope upward and forward.Insert the endotracheal tube from the right with its concave curve facing downward and to the right side of the patient.Maneuver the endotracheal tube into the larynx, midway between the cricoid cartilage and the sternal angle


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5.放牙垫，退喉镜 .确定位置后，妥善固定导管与牙垫．注套囊空气 (3-5m1).inflate the cuff and apply positive pressure ventilation while the assistant auscultates.Secure the endotracheal tube in position。


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并发症 Complications

声音嘶哑及咽痛 Postintubation hoarseness and sore throat

呕吐 VomitingAspiration局限性肺炎 Pneumonitis肺炎 Pneumonia心动过缓 Bradycardia


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并发症 Complications

喉痉挛 Laryngospasm支气管痉挛 Bronchospasm呼吸暂停 Apnea牙齿、嘴唇、声带的损伤。 Trauma to

teeth,lips and vocal cords.颈椎损伤加重。 Exacerbation of cervical

spine injuries.


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气管插管术